ATC Class:P03AB02
VA Class:AP300
Lindane is a scabicide and pediculicide.
Lindane is used for the topical treatment of pediculosis capitis (head lice infestation) and pediculosis pubis (pubic lice infestation) and for the topical treatment of scabies.102, 103, 104, 106, 117, 118, 121 Lindane, however, is a second-line agent for the treatment of pediculosis and scabies and the manufacturer and most clinicians recommend that the drug only be used in patients who have not responded to or cannot tolerate first-line agents.101, 103, 104, 112, 117, 118 Lindane is not effective in the prophylaxis of pediculosis or scabies and does not prevent infestation or reinfestation.117, 118
In the past, lindane was widely recommended for the treatment of pediculosis capitis caused by Pediculus humanis var capitis .101, 102, 112 However, lindane is no longer recommended as initial therapy for pediculosis capitis because of reports of resistance and neurotoxicity (e.g., seizures).101, 103, 104, 112, 117 Lindane can be used for the treatment of pediculosis capitis in patients who have not responded to or who cannot tolerate other recommended therapies.103, 117 The drug should not be used in premature infants, patients who have any known seizure disorder, and patients with a skin condition that may increase systemic absorption of the drug (e.g., atopic dermatitis, psoriasis).103, 117 (See Cautions: Precautions and Contraindications and see Cautions: Pediatric Precautions.)
Many clinicians now consider topical permethrin 1% the treatment of choice for lice infestation and topical malathion 0.5% the preferred agent when permethrin resistance is suspected. 103, 107 Some clinicians consider topical pyrethrins with piperonyl butoxide an alternative rather than a preferred treatment regimen because the ovicidal activity is low (without residual activity) and repeated application after 7-10 days is necessary to kill newly hatched lice.103, 103, 107 Oral ivermectin also has been recommended as an alternative pediculicide.107
Lindane is used for the treatment of pediculosis pubis caused by Phthirus pubis in patients who have not responded to or cannot tolerate other recommended therapies.117
Although there are few well-controlled comparative studies, the US Centers for Disease Control and Prevention (CDC) recommends use of permethrin 1% or pyrethrins with piperonyl butoxide for the treatment of pediculosis pubis.104 The CDC also includes lindane 1% (not recommended for pregnant or lactating women or children younger than 2 years of age) as a recommended regimen for the treatment of pediculosis pubis and states that lindane toxicity (i.e., seizures, aplastic anemia) has not been reported when treatment was limited to the recommended 4-minute period;104 however, most clinicians no longer recommend lindane 1% as initial therapy because of reports of resistance and neurotoxicity (e.g., seizures)103, 112 and lindane is now labeled by the US Food and Drug Administration (FDA) only for second-line therapy.117 Malathion 0.5% lotion has been used for the treatment of lice infestation,103, 107 and some clinicians recommend malathion as a pediculicide of choice.107 Oral ivermectin (a single dose of 200 mcg/kg) also has been recommended as an alternative pediculicide.107, 112
For infestation of the eyelashes with pubic lice, the CDC and others recommend treatment with an occlusive ophthalmic ointment (e.g., petrolatum) 2-4 times daily for 8-10 days;102, 103, 104, 106, 107, 111 nits should be removed from the eyelashes manually.103, 111
If used correctly, one treatment with lindane 1% usually is effective in eradicating pediculosis pubis. The CDC recommends reevaluating the patient 1 week after treatment if symptoms persist; retreatment with an alternative regimen may be necessary if lice or eggs are found.104 Because of concerns about neurotoxicity, retreatment with lindane should be avoided.117 Lindane is not effective in the prophylaxis of pediculosis and does not prevent infestation or reinfestation.117
Pediculosis pubis usually is transmitted by sexual contact.104 Presumptive concurrent treatment of sexual contacts to whom lice might have been spread within the last month is recommended.102, 103, 104 Patients should avoid sexual contact with their sexual partner(s) until patients and partners have been treated and reevaluated to rule out persistent disease.104 Presumptive concurrent treatment also has been recommended for other close contacts of the patient.111
The CDC states that patients with human immunodeficiency virus (HIV) infection who have pediculosis pubis should receive the same treatment as those without HIV infection.104 (See Cautions: Precautions and Contraindications.)
Lindane is used as an alternative agent for the topical treatment of scabies in patients who have not responded to or cannot tolerate other recommended therapies.104
The American Academy of Pediatrics (AAP), the CDC, and other clinicians consider permethrin 5% to be the scabicide of choice because of its safety and efficacy profile relative to other available agents, particularly lindane.103, 104, 105, 107, 111, 121 Recommendations for alternative therapy differ among various clinicians.103, 104, 107 Some clinicians recommend crotamiton 10% or oral ivermectin as alternatives.107 The CDC recommends lindane 1% (not recommended for pregnant or lactating women, children younger than 2 years of age, or individuals with extensive dermatitis) or oral ivermectin as alternative scabicides.104
In the past, lindane 1% was considered a scabicide of first choice;105, 121 however, resistance to the drug has been reported in some areas of the world, including the US, and neurotoxicity (e.g., seizures) and aplastic anemia occasionally have been reported following lindane treatment.101, 104, 105 Permethrin 5% is particularly preferred for the treatment of scabies in infants and young children and in pregnant and lactating women because of its low percutaneous absorption and relative topical safety;103, 104 lindane is not a suitable alternative for such patients or in those with extensive dermatitis because of the drug's topical toxicity profile.103, 104
Lindane should not be used for the treatment of Norwegian scabies because of the risks of neurotoxicity with heavy application and denuded skin.104, 117, 118 Norwegian scabies (crusted scabies) is a particularly severe and highly infectious form of scabies that usually occurs in immunocompromised, debilitated, or malnourished individuals and presents as crusted, hyperkeratotic, scaling plaques, which may be generalized or localized to the hands and feet.103, 104, 109, 113, 115 In this condition, the patient is infested with large numbers (thousands to millions) of Sarcoptes mites.108, 109, 113, 115 Patients with Norwegian scabies often require multiple treatments with scabicides,113 and it is important that the total body (including areas under the nails) be treated when topical therapy is used.108 Sequential use of several different scabicides may be necessary.113 Some clinicians pretreat patients with a keratolytic agent before using a topical scabicide.113 Other clinicians recommend therapy with a topical scabicide in conjunction with oral ivermectin.104 Some clinicians consider oral ivermectin the therapy of choice for patients whose infection is refractory to topical therapy;103 however, the comparative efficacy of ivermectin and standard scabies therapies remains to be established.104 The CDC recommends that patients with Norwegian scabies be managed in consultation with an expert.104
In less than 10% of patients with scabies, nodular scabies may develop, which is characterized by intensely pruritic nodules that persist for months after effective scabies therapy;103, 110 mites seldom are identified in these nodules.110 Scabicide therapy usually is ineffective in nodular scabies since mites typically are not present.110 Topical or intralesional corticosteroids may be useful to treat the pruritus associated with nodular scabies.110
The CDC states that patients with HIV infection who have uncomplicated scabies should receive the same treatment as those without HIV infection.104 (See Cautions: Precautions and Contraindications.) Some clinicians suggest use of permethrin 5% or, alternatively, lindane 1% or sulfur 5% ointment for the treatment of scabies in patients with HIV infection.108 These clinicians suggest that HIV-infected individuals routinely receive a second treatment with a scabicide 1 week after the first treatment or, alternatively, that treatment be repeated weekly until symptoms and lesions clear.108 Because of concerns about neurotoxicity, retreatment with lindane should be avoided.117, 118 Some clinicians recommend ivermectin for immunocompromised patients whose scabies is refractory to topical therapy.103, 108 Immunocompromised individuals, including those with HIV infection, are at increased risk of developing Norwegian scabies and such patients should be managed in consultation with an expert.104, 108, 113
If used correctly, one treatment with lindane 1% usually is effective in eradicating scabies. Experts disagree on the need for retreatment of scabies; some experts recommend retreatment if symptoms persist after 1 week, while others recommend retreatment only if live mites are observed.104 The CDC recommends retreatment with an alternative regimen in patients who fail to respond to lindane initially.104 Because of concerns about neurotoxicity, retreatment with lindane should be avoided.117, 118 Pruritus associated with scabies usually is not considered an indication for retreatment;104 such pruritus results from a hypersensitivity reaction of the host to the mite103, 104, 109, 111 and may persist for several weeks despite successful treatment.103, 109 Oral antihistamines and topical corticosteroids may be used to help relieve symptoms.103, 109, 113, 121 Many clinicians recommend follow-up examinations of patients 2 and 4 weeks after treatment.109 If the patient is not clear of new lesions at either examination, it should be considered a treatment failure; such treatment failures may be secondary to failure to treat all exposed individuals or failure to apply the drug properly.109 If the patient is clear of new lesions when examined at 2 weeks, but has new lesions at 4 weeks, it should be considered a reinfestation rather than a treatment failure.109 Mild infections secondary to scabies usually remit, but concurrent systemic anti-infective therapy may be necessary for severe secondary infections. Lindane is not effective in the prophylaxis of scabies and does not prevent infestation or reinfestation.118
Sexual contacts and other individuals who have had close personal contact with a patient with scabies within the previous month should be examined and treated.103, 104, 109, 113 Such individuals include household, family, and sexual contacts to whom scabies might have been spread.103, 109, 113
The CDC recommends that scabies epidemics in institutional settings (e.g., nursing homes, hospitals, residential facilities and communities) be managed in consultation with an expert.104 Control of such epidemics requires treatment of the entire population at risk.104, 114, 115 Permethrin has been recommended as a scabicide of choice in institutional outbreaks;114 other clinicians recommend either permethrin or lindane.115 Ivermectin may be useful in this setting, especially if treatment with topical scabicides fails.104
Lindane 1% lotion and lindane 1% shampoo are applied topically. Although lindane previously was available as a topical cream, this formulation of the drug is no longer commercially available in the US.
Lindane preparations are for external use only and should not be ingested. 117, 120(See Acute Toxicity.) Contact with the eyes and mouth should be avoided.117, 118, 119, 120 If contact with the eyes occurs, the eyes should be immediately flushed with water.117, 118, 120 Lindane preparations should not be used if open wounds, cuts, or sores are present at the site of application.117, 118
Administration Precautions for Parents and Caregivers
Parents or caregivers who apply lindane on an infected individual should wear gloves made of nitrile, latex with neoprene, or sheer vinyl; natural latex gloves should not be used since lindane can diffuse through natural latex gloves.117, 118, 119, 120 Hands should be thoroughly cleaned after application is completed.119, 120
When lindane shampoo is used, it should be applied to hair that is clean and completely dry.117, 119 At least 1 hour before applying lindane shampoo, the hair may be washed with regular shampoo (without conditioner) and dried completely.119 Use of oil treatments or oil-based hair preparations immediately before or after applying lindane shampoo should be avoided.117, 119
When lindane lotion is used, it should be applied to skin that is clean and free of any creams, ointments, or oil.118, 120, 120 Lindane lotion should not be applied to the skin immediately after a bath or shower.104, 118 Patients should wait at least 1 hour after bathing or showering and the skin should be completely dry before applying lindane lotion.118, 120
Measures to Avoid Reinfestation and Transmission
To avoid reinfestation or transmission following lindane treatment of pediculosis or scabies, all clothing, bed linens, and towels used within the last 72 hours should be machine-washed in hot water and dried in a hot dryer or dry-cleaned.117, 118, 119, 120, 121 Fumigation of living areas is not necessary. Many experts recommend particular attention to thorough cleaning of areas inhabited by patients with Norwegian scabies because of the large numbers of mites infesting these patients.115 For lice infestation, it is recommended that items that cannot be laundered or dry-cleaned be removed from contact and sealed in a plastic bag for 10 days.103 Combs and brushes used by the infected patient may be disinfected by soaking in hot water (temperature exceeding 53°C) for 5 minutes;103 alternatively, soaking in a pediculicide for 1 hour may be used.102 Combs and brushes may be washed with lindane shampoo, but they should be rinsed thoroughly with water to remove the drug. Since lindane may be toxic when misused, children should not be allowed to apply the drug without adult supervision.
For the treatment of pediculosis capitis (head lice infestation) caused by Pediculosis humanis var capitis or pediculosis pubis (pubic lice infestation) caused by Phthirus pubis , about 30-60 mL of lindane 1% shampoo is applied directly (without adding water) to hair that has been previously washed and dried completely.117 The amount of lindane shampoo needed depends on the length of the hair; most patients will require only 30 mL.117 The lindane shampoo should be worked thoroughly into the hair and allowed to stay in place for 4 minutes.117 Special attention should be given to the fine hairs along the neck and behind the ears.117 After 4 minutes, small quantities of water should be added to the hair; after a good lather forms, the hair should immediately be rinsed thoroughly until all the lather is gone.117 Avoid unnecessary contact of lather with other body parts.117
The hair is then dried with a clean towel, and combed with a fine tooth comb to remove any remaining nit shells.117 For further information on application of lindane shampoo, the patient information provided by the manufacturer should be consulted.119 Lindane or other pediculicides should not be used for the treatment of pediculosis of the eyelashes; instead, an occlusive ophthalmic ointment (e.g., petrolatum) should be applied to the eyelid margins 2-4 times daily for 8-10 days to smother lice and nits.102, 103, 104
Although one treatment with lindane usually is successful, retreatment with an alternative pediculicide may be appropriate at the advice of the clinician if live lice or nits are detected after 1 week. Because of concerns about neurotoxicity, retreatment with lindane should be avoided.117, 118
For the treatment of scabies caused by Sarcoptes scabiei , a thin layer of lindane 1% lotion should be applied uniformly and gently massaged into all skin surfaces (entire trunk and extremities) from the neck to the toes (including the soles of the feet). For further information on application of lindane lotion, the patient information provided by the manufacturer should be consulted.120 Scabies rarely affects the head of adults but may affect the head of infants and young children. The drug should not be applied to the face, eyes, mucous membranes, or urethral meatus. Approximately 30 mL of the lotion is recommended for an average adult.118
After 8-12 hours, lindane lotion must be completely washed off the body using warm (not hot) water.118, 120 The lotion should never be left on the skin for longer than 12 hours.118
One treatment with lindane usually is successful. Additional treatment with an alternative scabicide generally is warranted only if live mites can be demonstrated. Because of concerns about neurotoxicity, retreatment with lindane should be avoided.117, 118
When used in appropriate concentrations and dosages, topically applied lindane generally appears to have a low order of toxicity. However, neurotoxicity, including seizures and deaths, has occurred following repeated or prolonged application of lindane shampoo or lotion and has rarely been reported after a single application.117, 118 Serious CNS effects have occurred more frequently with lindane lotion than with lindane shampoo.117, 118
Adverse effects with serious outcome (hospitalization, disability, death) have been associated with use of lindane shampoo and lotion and, in about 20% of reported cases, lindane was used according to the manufacturers' directions.117, 118 Thirteen deaths have been reported in patients who used lindane shampoo or lotion; in many of these cases, death was remote from the time of use of lindane.117, 118 Lindane toxicity was established as the cause of death in one infant.117, 118 In addition, lindane toxicity was the cause of death in one adult who ingested the drug orally in a successful suicide.117, 118 (See Acute Toxicity.) The cause of death for other cases have been attributed to causes other than lindane toxicity.117, 118
Adverse CNS effects, including dizziness and seizures, have been reported with lindane.117, 118 While seizures generally have been associated with ingestion or misuse of lindane, seizures and deaths rarely have been reported following a single application of lindane shampoo or lotion used according to the manufacturers' directions.117, 118 Infants, children, geriatric patients, patients weighing less than 50 kg, and patients with certain other skin conditions may be at greater risk of serious neurotoxicity than other individuals.117, 118
Although the relationship to lindane is unknown, headache, pain, and paresthesia have been reported with lindane shampoo or lotion.117, 118
Dermatologic and Sensitivity Reactions
Alopecia,117, 118 dermatitis,117, 118 pruritus,117, 118 and urticaria117, 118 have been reported in patients using lindane shampoo or lotion.117, 118
In patients with scabies or pediculosis, pruritus (caused by an acquired sensitivity to the ectoparasites and their products) frequently persists for one to several weeks following treatment with the drug; this reaction does not indicate treatment failure and is not an indication for further treatment.117, 118 Oral antihistamines and/or topical corticosteroids may be used to help relieve pruritus.103, 109, 113
Aplastic anemia has been reported with prolonged administration of lindane lotion. (See Acute Toxicity.)
Inhalation of lindane vapors may produce headache, nausea, vomiting, and irritation of eyes, nose, and throat.
Precautions and Contraindications
Because lindane has been associated with neurotoxicity, including seizures and fatalities, recommended application procedures should be followed and recommended dosages should not be exceeded . The fact that lindane can be absorbed through intact skin following topical application and has the potential for CNS toxicity should be considered whenever the drug is used. Lindane is applied topically in a single dose, and repeated application should be avoided.117, 118 It is not known how soon after a single application of lindane lotion that a second application can be safely applied.118 Infants, children, geriatric patients, patients weighing less than 50 kg, and patients with certain other skin conditions may be at greater risk of serious neurotoxicity than other patients.117, 118 Careful consideration should be employed before prescribing lindane shampoo or lotion for patients at increased risk of seizure; such individuals include those with human immunodeficiency virus (HIV) infection, a history of head trauma, seizure history, CNS tumor, severe hepatic cirrhosis, excessive alcohol consumption, concomitant use of agents that lower the seizure threshold, and those undergoing abrupt discontinuance of alcohol or sedatives.117, 118
Patients or their caregivers should be instructed on the proper use of lindane shampoo or lotion, including the amount to apply, how soon to wash the drug off, and the importance of avoiding repeated application of lindane.117, 118 Patients should be advised that pruritus may persist after successful treatment of pediculosis or scabies and is not an indication for further treatment.117, 118 Patients or their caregivers should be provided with a copy of the manufacturer's patient information at the time the drug is dispensed.117, 118 Seizures have been reported in patients receiving lindane following a bath; therefore, patients should wait at least 1 hour after bathing or showering before applying lindane lotion.118, 120 Patients should wait at least 1 hour after washing their hair before applying lindane shampoo.117, 119 Seizures have not been reported following use of lindane shampoo when used for about 4 minutes as indicated for the treatment of pediculosis.
Lindane should not be applied to patients with extensive dermatitis or to those with acutely inflamed skin or raw, weeping surfaces. If primary irritation or hypersensitivity occurs, treatment should be discontinued and the drug should be removed with soap and water.
Lindane is contraindicated in premature neonates (see Cautions: Pediatric Precautions) and in patients with uncontrollable seizure disorders.117, 118 Lindane also is contraindicated in patients with Norwegian scabies (crusted scabies) and in those with other skin disorders (e.g., atopic dermatitis, psoriasis) since systemic absorption of the drug might be increased in these patients.117, 118
Lindane is contraindicated in patients with a history of sensitivity to the drug or any ingredient in the commercially available preparations.117, 118
Lindane should be used with caution in infants and small children since they are at risk of serious neurotoxicity.117, 118 Pediatric patients have a higher surface-to-volume ratio than adults and may be at risk of greater systemic absorption following topical application of lindane.117, 118 In addition, infants and children may be at greater risk than older individuals because of immature organ systems (e.g., skin, liver).117, 118 Lindane should be used with caution in individuals weighing less than 50 kg, especially infants.117, 118
Lindane is contraindicated in premature neonates since their skin might be more permeable than full-term neonates and their liver enzymes not sufficiently developed to metabolize lindane.117, 118 In addition, the CDC currently recommends that alternative therapies be used in infants and children younger than 2 years of age.104
If lindane is used in children, care should be taken to prevent ingestion of the drug as from thumbsucking (by covering hands and feet). Children must not be allowed to apply lindane without adult supervision.
Safety and efficacy of lindane have not been specifically studied in geriatric patients.117, 118 Lindane shampoo and lotion should be used with caution in geriatric individuals since this age group may be at increased risk of serious neurotoxicity.117, 118 There have been at least 4 reports of death in geriatric adults following application of lindane lotion for the treatment of scabies.117, 118 Two of these patients died within 24 hours of application of the drug, one died 41 days after application and had a seizure on the day of death, and one died of an unreported cause of death on the day of treatment.117, 118
Mutagenicity and Carcinogenicity
Lindane did not exhibit mutagenic effects in bacterial studies and did not cause sister chromatid exchange in an in vivo assay.117, 118
Although no studies have been conducted with lindane shampoo or lotion, numerous long-term feeding studies in mice and rats have evaluated the carcinogenic potential of the technical grade of hexachlorocyclohexane as well as the isomers of the drug (including lindane).117, 118 An increased incidence of neoplasms was not clearly related to administration of lindane.117, 118
Pregnancy, Fertility, and Lactation
Lindane shampoo and lotion should be used during pregnancy only when clearly needed.117, 118 The CDC currently states that lindane is not recommended for use in pregnant or nursing women.104 There are no adequate and controlled studies to date evaluating use of lindane shampoo or lotion in pregnant women.117, 118 There are no known maternal or fetal health risks if pediculosis or scabies is not treated,117, 118 although the risk of transmission of pediculosis to other household members may be an additional consideration when deciding whether to use a pediculicide.117
Lindane is lipophilic and may accumulate in the placenta.117, 118 Although the relationship of maternal exposure to the fetal outcome is unknown, there has been at least one report of a stillborn infant born to a woman who received multiple exposures to lindane lotion during the pregnancy.117, 118
In a fertility study in rats, there was a reduction in the number of spermatids in the testes of rats 2 weeks after oral administration of a single lindane dose of 30 mg/kg (12 times the estimated human exposure for treatment of scabies assuming 50% rat oral bioavailability and 10% human topical bioavailability).117, 118
Lindane is distributed into human milk.117, 118 There may be risk of toxicity if lindane were ingested from milk; in addition, there is risk of toxicity if lindane were absorbed through the skin in the course of breastfeeding if the mother has applied lindane to the chest area.117, 118 Women who are breast-feeding and require therapy with lindane should be advised of the potential risks; these women should be advised to interrupt breast-feeding and to express and discard breast milk for at least 24 hours following application of lindane.117, 118 In addition, women who are breast-feeding and use lindane lotion should be advised to avoid large areas of skin-to-skin contact with the infant while lindane is applied.118 Breast-feeding women using lindane shampoo should be advised not to apply the shampoo to the skin.119
Drugs that Lower the Seizure Threshold
Lindane should be used with caution in patients receiving concomitant therapy with drugs that lower the seizure threshold (e.g., antidepressants, antipsychotics, centrally active anticholinesterases, chloroquine sulfate, cyclosporine, imipenem, isoniazid, meperidine, methocarbamol, mycophenolate mofetil, penicillins, pyrimethamine, quinolones, radiographic contrast agents, tacrolimus, theophylline).117, 118
Oils and Oil-based Preparations
Oil may enhance the percutaneous absorption of lindane.117, 118 Use of oil treatments or oil-based hair preparations immediately before or after applying lindane shampoo should be avoided117, 119 and lindane lotion should not be applied simultaneously with any other cream, ointment, or oil.118, 120
Lindane is absorbed through skin and mucous membranes and from the GI tract, and has occasionally caused serious CNS (e.g., seizures), hepatic, and renal toxicity which rarely may result in death. Lindane toxicity has been reported when the topical drug was used excessively or for prolonged periods and following accidental or intentional ingestion. Misuse of topical lindane and subsequent toxicity often has occurred as the result of lack of understanding of directions regarding use by the patient, administration of higher than recommended dosages, or improper reapplication of the drug. However, seizures also have been reported very rarely following recommended application of topical lindane. In at least one patient receiving prolonged administration (applied from neck to knees twice daily for 3 weeks) of lindane lotion, severe aplastic anemia (resistant to antithymocyte globulin) and elevated liver function test results were reported. Three years after application of lindane lotion in this patient, there was a substantial improvement in white and red blood cell counts; however, thrombocytopenia persisted.
Following accidental oral ingestion or systemic absorption of topically applied lindane, CNS stimulation characterized by vomiting, restlessness, muscle spasms, ataxia, and clonic and tonic seizures may occur. CNS depression may precipitate respiratory failure and coma; death may occur within 24 hours. Bradycardia, sinus arrhythmia, ventricular fibrillation, pulmonary edema, bladder irritation, microscopic hematuria, and hepatitis also have been reported following accidental ingestion of lindane. Lindane toxicity was the cause of death in at least one adult who intentionally ingested the drug in a successful suicide.117, 118 The mean lethal oral dose of lindane in humans is reported to be approximately 125 mg/kg.
To minimize absorption of lindane following accidental or intentional ingestion, gastric lavage should be performed immediately and saline cathartics administered; oil laxatives may promote absorption of lindane and, therefore, should not be used.117, 118 CNS manifestations may be treated with IV diazepam, pentobarbital, or phenobarbital.117, 118 Epinephrine should not be used as it may precipitate ventricular fibrillation.
Lindane is a CNS stimulant when absorbed systemically. Following absorption through the chitinous exoskeleton of arthropods, cyclic chlorinated hydrocarbons like lindane presumably stimulate the nervous system, resulting in seizures and death.
Lindane is toxic to the parasitic arthropod Sarcoptes scabiei (the causative organism of scabies) and their eggs. Lindane is also toxic to Pediculus humanus var capitis (head louse), Pediculus humanus var corporis (body louse), and Phthirus pubis (pubic or crab louse), and possibly their nits.
Resistance to lindane may develop in strains of Pediculus humanis var capitis . Although resistance of Sarcoptes scabiei to the drug has been reported, it has not been conclusively demonstrated.
Lindane is slowly and incompletely absorbed through intact skin when applied topically, from the GI tract when ingested, and through the mucous membranes when inhaled. Following topical application of 4 mcg of radiolabeled lindane (in acetone) per cm2 of intact forearm surface area in adults in one study, 5.6-13% (mean 9.3%) of the dose was absorbed systemically. Percutaneous absorption usually is greater when the drug is applied to the face, scalp, axillae, neck, scrotum, or damaged or occluded skin. Total body application of lindane lotion in infants and children with scabies has resulted in mean peak blood concentrations of 28 ng/mL 6 hours after application.117
Lindane is stored in body fat, metabolized by the liver, and excreted in urine and feces. Lindane is distributed into human milk.117, 118
The half-life of lindane in blood is approximately 18 hours.117, 118 Data suggest that the drug has a rapid distribution phase followed by a longer elimination phase.117, 118
Lindane is a cyclic chlorinated hydrocarbon originally developed as an agricultural insecticide. Technical grade lindane is a mixture of 9 stereoisomers, the gamma isomer usually representing 10-15% of the total chemical. The gamma isomer, extracted from technical grade lindane by organic solvents, occurs as a white, crystalline powder having a slightly musty odor. The drug is practically insoluble in water and soluble in organic solvents.
Lindane is commercially available for topical administration as a shampoo and a lotion.117, 118 The shampoo contains lindane 1% and also contains trolamine lauryl sulfate, polysorbate 60, acetone, and water; pH may have been adjusted with citric acid and/or trolamine.117 The lotion contains lindane 1% and also contains glycerol monostearate, cetyl alcohol, stearic acid, trolamine, carrageenan, 2-amino-2-methyl-propanol, methylparaben, butylparaben, perfume, and water.118
Commercially available lindane 1% shampoo and 1% lotion should be stored at a controlled room temperature of 15-30°C.117, 118
Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.
Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations.
Routes | Dosage Forms | Strengths | Brand Names | Manufacturer |
|---|---|---|---|---|
Topical | Lotion | 1%* | Lindane Lotion | |
Shampoo | 1%* | Lindane Shampoo |
* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name
AHFS® Drug Information. © Copyright, 1959-2025, Selected Revisions January 1, 2009. American Society of Health-System Pharmacists, Inc., 4500 East-West Highway, Suite 900, Bethesda, MD 20814.
Only references cited for selected revisions after 1984 are available electronically.
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